Bases anatómicas de la hemisferotomía periinsular
Palabras clave:
HEMISFERECTOMÍA, CORTEZA CEREBRALResumen
Introducción: la hemisferectomía se utiliza como tratamiento quirúrgico en pacientes seleccionados, portadores de crisis parciales incontrolables, y que asocian déficit motor progresivo. Esta técnica ha sido objeto de modificaciones hacia tratamientos desconectivos, con conservación del parénquima (hemisferotomía). La primera modificación importante la realizó Rasmussen, quien describió la hemisferectomía funcional. En el año 1992, Delalande describe la hemisferotomía y, en 1995, Villemure y Mascott realizan la hemisferotomía periinsular.
Objetivo: evidenciar desde el punto de vista anatómico los fascículos de sustancia blanca interrumpidos en la hemisferotomía periinsular.
Material y método: se utilizaron siete hemisferios cerebrales de cadáveres adultos. En dos se hicieron cortes axiales, sagitales y coronales; cinco se disecaron con la técnica de Klingler.
Resultados: la hemisferotomía periinsular se inicia con la ventana suprainsular. A través de la misma se seccionan las fibras de la transición corona radiata-cápsula interna. Luego se hace una callosotomía endoventricular, resección frontobasal y de la comisura blanca anterior. En el segundo paso (ventana infrainsular) se seccionan el pedúnculo temporal, trígono y se resecan las estructuras temporomesiales. Todos los fascículos y estructuras anatómicas resecadas o seccionadas fueron puestos en evidencia mediante disección, lo que permite tener una cabal concepción tridimensional del procedimiento.
Citas
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3) Peacock WJ. Neurosurgical aspects of epilepsy in children. In: Youmans JR, ed. Neurological surgery. 4th ed. Philadelphia: WB Saunders, 1996: 3624-42.
4) Peacock WJ, Comair YG, Hovda DA. Hemispherectomy for intractable seizures of childhood. In: Apuzzo MLJ, ed. Neurosurgical aspects of epilepsy. Park Ridge: AANS, 1991: 187-98.
5) Villarejo F, Comair Y. Surgical tratment of pediatric epilepsy. In: Choux M, Di Rocco C, Hockley A, Walker M, eds. Pediatric neurosurgery. Hong Kong: Churchill Livingstone, 1999: 717-40.
6) Bittar RG, Rosenfeld JV, Klug GL, Hopkins IJ, Simon Harvey A. Resective surgery in infants and young children with intractable epilepsy. J Clin Neurosci 2002; 9(2): 142-6.
7) Dandy WE. Removal of right cerebral hemisphere for certain tumors with hemiplegia. JAMA 1928; 90(11): 823-5.
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9) Davies KG, Maxwell RE, French LA. Hemispherectomy for intractable seizures: long-term results in 17 patients followed for up to 38 years. J Neurosurg 1993; 78(5): 733-40.
10) Laine E, Gros C. L'hémisphérectomie. Paris: Masson, 1956.
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12) Villemure JG. Cerebral hemispherectomy for epilepsy. In: Schmidek H, Sweet W, eds. Operative Neurosurgical Techniques, 3rd ed. Philadelphia: W B Saunders, 1995: 1351-8.
13) Delalande O, Pinard J, Basdevant C, Gauthe M, Plouin P, Dulac O. Hemispherotomy: A new procedure for central disconnection. Epilepsia 1992; 33(Suppl 3): 99-100 [Abstract].
14) Kanev PM, Foley CM, Miles D. Ultrasound-tailored functional hemispherectomy for surgical control of seizures in children. J Neurosurg 1997; 86(5): 762-7.
15) Morino M, Shimizu H, Ohata K, Tanaka K, Hara M. Anatomical analysis of different hemispherotomy procedures based on dissection of cadaveric brains. J Neurosurg 2002; 97(2): 423-31.
16) Schramm J, Behrens E, Entzian W. Hemispherical deafferentation: an alternative to functional hemispherectomy. Neurosurgery 1995; 36(3): 509-16; discussion 515-6.
17) Schramm J, Behrens E. Functional hemispherectomy. J Neurosurg 1997; 87(5): 801-2.
18) Shimizu H, Maehara T. Modification of peri-insular hemispherotomy and surgical results. Neurosurgery 2000; 47(2): 367-73.
19) Villemure JG, Mascott CR. Peri-insular hemispherotomy: surgical principles and anatomy. Neurosurgery 1995; 37(5): 975-81.
20) Winston KR, Welch K, Adler JR, Erba G. Cerebral hemicorticectomy for epilepsy. J Neurosurg 1992; 77(6): 889-95.
21) Arana R, Queirolo C, San Julian J. Hemisferectomía. A propósito de una observación. Arch Pediatr Uruguay 1957; 28(3): 145-54.
22) Arana R, Rebollo MA, Sande MT. Hemisferectomías. A propósito de 4 casos. Arch Pediatr Uruguay 1959; 30(11): 657-68.
23) Ture U, Yasargil MG, Friedman AH, Al-Mefty O. Fiber dissection technique: lateral aspect of the brain. Neurosurgery 2000; 47(2): 417-26; discussion 426-7.
24) Klingler J, Gloor P. The connections of the amygdala and of the anterior temporal cortex in the human brain. J Comp Neurol 1960; 115: 333-69.
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29) Nathoo N, Mayberg MR, Barnett GH. W James Gardner: pioneer neurosurgeon and inventor. J Neurosurg 2004; 100(5): 965-73.
30) Schramm J. Hemispherectomy techniques. Neurourg Clin N Am 2002; 13(1): 113-34.
31) Falconer MA, Wilson PJ. Complications related to delayed hemorrhage after hemispherectomy. J Neurosurg 1969; 30(4): 413-26.
32) Oppenheimer DR, Griffith HB. Persistent intracranial bleeding as a complication of hemispherectomy. J Neurol Neurosurg Psychiatry 1966; 29(3): 229-40.
33) Arroyo S, Vining EP, Pardo C, Carson B, Freeman JM. Insular seizures in patients with Rasmussen's syndrome. Epilepsia 1994; 35(Suppl 8): 50 [Abstract].
34) Freeman JM, Arroyo S, Vining EP. Insular seizures: a study in Sutton's law. Epilepsia 1994; 35(Suppl 8): 49. [Abstract].
35) Waxman SG. Correlative neuroanatomy, 24th ed. New York: Lange Medical Books, Mc Graw-Hill, 2000: 189-207.
36) Rebollo MA, Soria VR. Neuroanatomía. 2ª ed. Buenos Aires: Interamericana, 1988: 422-35.
37) Martin JM. Neuroanatomía, 2ª ed. Madrid: Pearson Educación, 1998: 249-87.
38) Pandya DN, Karol EA, Lele PP. The distribution of anterior commissure in the squirrel monkey. Brain Res 1973; 49(1): 177-80.
39) Pandya DN, Rosene DL. Some observations on trajectories and topography of commissural fibers. In: Reeves AG, ed. Epilepsy and the corpus callous. New York: Plenum Press, 1985: 21-40.
40) Barbas H, Pandya DN. Architecture and intrinsic connections of the prefrontal cortex in the rhesus monkey. J Comp Neurol 1989; 286(3): 353-75.
41) Rhoton AL Jr. The cerebrum. Neurosurgery 2002; 51(4 Suppl): S1-51.
42) Varnavas GG, Grand W. The insular cortex: morphological and vascular anatomic characteristics. Neurosurgery 1999; 44(1): 127-36; discussion 136-8.
43) Goldman Rakic PS. Anatomical and functional circuits in prefrontal cortex of nonhuman primates. Relevance to epilepsy. In: Jasper HH, Riggio S, Goldman Rakic PS, eds. Epilepsy and the functional anatomy of the frontal lobe. New York: Raven Press, 1995: 51-65.
44) Roberts DW. Callosal sectioning for the treatment of epilepsy. In: Apuzzo MLJ, ed. Neurosurgical aspects of epilepsy. Park Ridge: AANS, 1991: 171-83.
45) Mittal S, Farmer JP, Rosenblatt B, Andermann F, Montes JL Villemure JG. Intractable epilepsy after a functional hemispherectomy: important lessons from an unusual case. Case report. J Neurosurg 2001; 94(3): 510-4.
46) Bouchet A, Cuilleret J. Anatomía descriptiva, topográfica y funcional. Sistema nervioso central. Buenos Aires: Médica Panamericana, 1997.
47) Wen HT, Rhoton AL Jr, de Oliveira E, Cardoso AC, Tedeschi H, Baccanelli M, et al. Microsurgical anatomy of the temporal lobe: part 1: mesial temporal lobe anatomy and its vascular relationships as applied to amygdalohippocampectomy. Neurosurgery 1999; 45(3): 549-92.
2) Porter RJ. Epilepsy: prevalence, classification, diagnosis and prognosis. In: Apuzzo MLJ, ed. Neurosurgical aspects of epilepsy. Park Ridge: AANS, 1991: 17-26.
3) Peacock WJ. Neurosurgical aspects of epilepsy in children. In: Youmans JR, ed. Neurological surgery. 4th ed. Philadelphia: WB Saunders, 1996: 3624-42.
4) Peacock WJ, Comair YG, Hovda DA. Hemispherectomy for intractable seizures of childhood. In: Apuzzo MLJ, ed. Neurosurgical aspects of epilepsy. Park Ridge: AANS, 1991: 187-98.
5) Villarejo F, Comair Y. Surgical tratment of pediatric epilepsy. In: Choux M, Di Rocco C, Hockley A, Walker M, eds. Pediatric neurosurgery. Hong Kong: Churchill Livingstone, 1999: 717-40.
6) Bittar RG, Rosenfeld JV, Klug GL, Hopkins IJ, Simon Harvey A. Resective surgery in infants and young children with intractable epilepsy. J Clin Neurosci 2002; 9(2): 142-6.
7) Dandy WE. Removal of right cerebral hemisphere for certain tumors with hemiplegia. JAMA 1928; 90(11): 823-5.
8) Lhermitte J. L'ablation complète de l'hemisphère droit dans les cas des tumeur cérébrale localisée compliquée d'hémiplégie. La décérébration supra-thalamique unilatérale chez l'homme. Encephale 1928; 23: 314-23.
9) Davies KG, Maxwell RE, French LA. Hemispherectomy for intractable seizures: long-term results in 17 patients followed for up to 38 years. J Neurosurg 1993; 78(5): 733-40.
10) Laine E, Gros C. L'hémisphérectomie. Paris: Masson, 1956.
11) Krynauw RA. Infantile hemiplegia treated by removing one cerebral hemisphere. J Neurol Neurosurg Psychiat 1950; 13: 243-67.
12) Villemure JG. Cerebral hemispherectomy for epilepsy. In: Schmidek H, Sweet W, eds. Operative Neurosurgical Techniques, 3rd ed. Philadelphia: W B Saunders, 1995: 1351-8.
13) Delalande O, Pinard J, Basdevant C, Gauthe M, Plouin P, Dulac O. Hemispherotomy: A new procedure for central disconnection. Epilepsia 1992; 33(Suppl 3): 99-100 [Abstract].
14) Kanev PM, Foley CM, Miles D. Ultrasound-tailored functional hemispherectomy for surgical control of seizures in children. J Neurosurg 1997; 86(5): 762-7.
15) Morino M, Shimizu H, Ohata K, Tanaka K, Hara M. Anatomical analysis of different hemispherotomy procedures based on dissection of cadaveric brains. J Neurosurg 2002; 97(2): 423-31.
16) Schramm J, Behrens E, Entzian W. Hemispherical deafferentation: an alternative to functional hemispherectomy. Neurosurgery 1995; 36(3): 509-16; discussion 515-6.
17) Schramm J, Behrens E. Functional hemispherectomy. J Neurosurg 1997; 87(5): 801-2.
18) Shimizu H, Maehara T. Modification of peri-insular hemispherotomy and surgical results. Neurosurgery 2000; 47(2): 367-73.
19) Villemure JG, Mascott CR. Peri-insular hemispherotomy: surgical principles and anatomy. Neurosurgery 1995; 37(5): 975-81.
20) Winston KR, Welch K, Adler JR, Erba G. Cerebral hemicorticectomy for epilepsy. J Neurosurg 1992; 77(6): 889-95.
21) Arana R, Queirolo C, San Julian J. Hemisferectomía. A propósito de una observación. Arch Pediatr Uruguay 1957; 28(3): 145-54.
22) Arana R, Rebollo MA, Sande MT. Hemisferectomías. A propósito de 4 casos. Arch Pediatr Uruguay 1959; 30(11): 657-68.
23) Ture U, Yasargil MG, Friedman AH, Al-Mefty O. Fiber dissection technique: lateral aspect of the brain. Neurosurgery 2000; 47(2): 417-26; discussion 426-7.
24) Klingler J, Gloor P. The connections of the amygdala and of the anterior temporal cortex in the human brain. J Comp Neurol 1960; 115: 333-69.
25) Ture U, Yasargil DC, Al-Mefty O, Yasargil MG. Topographic anatomy of the insular region. J Neurosurg 1999; 90(4): 720-33.
26) Ture U, Yasargil MG, Al-Mefty O, Yasargil DC. Arteries of the insula. J Neurosurg 2000; 92(4): 676-87.
27) Yasargil MG. Microneurosurgery, Vol IVA: CNS tumors: surgical anatomy, neuropathology, neuroradiology, neurophysiology, clinical considerations, operability, treatment options. Stuttgart: Georg Thieme Verlag, 1994: 14-69.
28) González LF, Smith K. Meyer's loop. Barrow Quart 2002; 18(1): 4-7.
29) Nathoo N, Mayberg MR, Barnett GH. W James Gardner: pioneer neurosurgeon and inventor. J Neurosurg 2004; 100(5): 965-73.
30) Schramm J. Hemispherectomy techniques. Neurourg Clin N Am 2002; 13(1): 113-34.
31) Falconer MA, Wilson PJ. Complications related to delayed hemorrhage after hemispherectomy. J Neurosurg 1969; 30(4): 413-26.
32) Oppenheimer DR, Griffith HB. Persistent intracranial bleeding as a complication of hemispherectomy. J Neurol Neurosurg Psychiatry 1966; 29(3): 229-40.
33) Arroyo S, Vining EP, Pardo C, Carson B, Freeman JM. Insular seizures in patients with Rasmussen's syndrome. Epilepsia 1994; 35(Suppl 8): 50 [Abstract].
34) Freeman JM, Arroyo S, Vining EP. Insular seizures: a study in Sutton's law. Epilepsia 1994; 35(Suppl 8): 49. [Abstract].
35) Waxman SG. Correlative neuroanatomy, 24th ed. New York: Lange Medical Books, Mc Graw-Hill, 2000: 189-207.
36) Rebollo MA, Soria VR. Neuroanatomía. 2ª ed. Buenos Aires: Interamericana, 1988: 422-35.
37) Martin JM. Neuroanatomía, 2ª ed. Madrid: Pearson Educación, 1998: 249-87.
38) Pandya DN, Karol EA, Lele PP. The distribution of anterior commissure in the squirrel monkey. Brain Res 1973; 49(1): 177-80.
39) Pandya DN, Rosene DL. Some observations on trajectories and topography of commissural fibers. In: Reeves AG, ed. Epilepsy and the corpus callous. New York: Plenum Press, 1985: 21-40.
40) Barbas H, Pandya DN. Architecture and intrinsic connections of the prefrontal cortex in the rhesus monkey. J Comp Neurol 1989; 286(3): 353-75.
41) Rhoton AL Jr. The cerebrum. Neurosurgery 2002; 51(4 Suppl): S1-51.
42) Varnavas GG, Grand W. The insular cortex: morphological and vascular anatomic characteristics. Neurosurgery 1999; 44(1): 127-36; discussion 136-8.
43) Goldman Rakic PS. Anatomical and functional circuits in prefrontal cortex of nonhuman primates. Relevance to epilepsy. In: Jasper HH, Riggio S, Goldman Rakic PS, eds. Epilepsy and the functional anatomy of the frontal lobe. New York: Raven Press, 1995: 51-65.
44) Roberts DW. Callosal sectioning for the treatment of epilepsy. In: Apuzzo MLJ, ed. Neurosurgical aspects of epilepsy. Park Ridge: AANS, 1991: 171-83.
45) Mittal S, Farmer JP, Rosenblatt B, Andermann F, Montes JL Villemure JG. Intractable epilepsy after a functional hemispherectomy: important lessons from an unusual case. Case report. J Neurosurg 2001; 94(3): 510-4.
46) Bouchet A, Cuilleret J. Anatomía descriptiva, topográfica y funcional. Sistema nervioso central. Buenos Aires: Médica Panamericana, 1997.
47) Wen HT, Rhoton AL Jr, de Oliveira E, Cardoso AC, Tedeschi H, Baccanelli M, et al. Microsurgical anatomy of the temporal lobe: part 1: mesial temporal lobe anatomy and its vascular relationships as applied to amygdalohippocampectomy. Neurosurgery 1999; 45(3): 549-92.
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Martínez F, Soria Vargas VR, Sgarbi N, Laza S, Prinzo H. Bases anatómicas de la hemisferotomía periinsular. Rev. Méd. Urug. [Internet]. 31 de diciembre de 2004 [citado 27 de diciembre de 2024];20(3):208-14. Disponible en: https://revista.rmu.org.uy/index.php/rmu/article/view/875
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